LOUISIANA PAIN

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8 LOUISIANA PAIN QUARTERLY Vol. 27 “We have the ability to share our expertise together and design treatment plans that will benefit our patients the most.” I was exposed to the specialty of pain management at an early age through my brother Tarun Jolly, which provided me a head start in this field when compared to my colleagues. Now, the two of us have the ability to share our expertise together at Louisiana Pain Specialists and design treatment plans that will benefit our patients the most. You’ve just finished your residency and fellowship. How has the field changed since you completed your training? The field has changed dramatically, and for the better. A decade ago, patients and even physicians were unaware that ‘pain management’ existed, meaning that patients often dealt with suboptimal pain control. Now, however, we are increasingly aware of the severe consequences of untreated pain, resulting in a massive amount of published research paving the way for new therapies. A great example is spinal cord stimulation (also called neuromodulation), a minimally invasive therapy that provides excellent relief of various pain conditions affecting the spine and extremities. When it was first introduced, neuromodulation was used only as a treatment for leg pain. Today, however, we have discovered that it can be life-changing for patients that have chronic pain in their neck, back, arms, legs, and even various head pain syndromes! Other examples of advancements in pain management include the use of smaller needles, smaller incisions, and more precise imaging – ultimately meaning safer, quicker, and more effective procedures for our patients. Without a doubt, new technologies are a major part of the field. But are traditional approaches still valuable in pain management? For patients new to technology, how do older forms of diagnosis and treatment still enter in? Great question. As mentioned earlier, perhaps the most active research in pain management focuses on neuromodulation. In this procedure, we implant very
Vol. 27 LOUISIANA PAIN QUARTERLY 9 small wires that stimulate a patient’s spine through tiny electrodes, which in turn prevents the perception of certain pain signals and can ultimately relieve or even eliminate chronic pain. These treatments by far have been the most impressive development in the field. Additionally, radiofrequency lesioning, an old technique that has become more advanced, can essentially dissect a painful nerve very quickly to provide relief in many areas including the back, neck, hip, knee, foot, and head. With new research identifying exactly which nerves cause certain types of pain, this lesioning has become far more effective, providing us the ability to identify appropriate targets and perform precise interventions. Traditionally, we consider the ‘old-fashioned’ approaches to pain management to be medications, exercise, physical therapy, and dieting, which are all extremely important components in treating a patient’s pain. We call this a multi-modal approach, which simply means that we include interventions, as outlined above, alongside medications and conservative treatments such as physical therapy and dieting to treat our patients. Research has backed this idea for years, that patients get better using more than one treatment plan rather than just one alone. While there is concern about prescribing certain medications safely, my duty as an ACGME-trained pain management physician is to find the right medication(s) for my patients and prescribe them at the right dose, keeping patient safety in mind. Certain conditions – such as nerve-related pain or joint-related pain – will require supplemental medications to provide more complete relief. But we combine this technique with other approaches such as exercise and dieting to give our patients the widest path to pain relief. What types of procedures do you perform? I can perform safely and effectively everything from simple joint injections in the office, to highly specialized procedures including minimally invasive spinal cord neuromodulation. Pain management is not a field where one can provide expertise by implementing only one or two approaches. Instead, we as pain physicians must utilize every piece of technology and knowledge we have in order to provide our patients the best opportunity for success. This means that I apply ultrasound guided
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